Strategies in Trauma and Limb Reconstruction

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VOLUME 18 , ISSUE 3 ( September-December, 2023 ) > List of Articles


Universal Long Bone Nonunion Classification

Leonid N Solomin, Anton A Semenistyy, Artem V Komarov, Vladimir V Khominets, Gerard A Sheridan, S Robert Rozbruch

Keywords : Aseptic nonunion, Atrophic nonunion, Bone defect, Bone loss, Classification, Hypertrophic nonunion, Nonunion, Normotrophic nonunion, Oligotrophic nonunion, Pseudarthrosis

Citation Information : Solomin LN, Semenistyy AA, Komarov AV, Khominets VV, Sheridan GA, Rozbruch SR. Universal Long Bone Nonunion Classification. 2023; 18 (3):169-173.

DOI: 10.5005/jp-journals-10080-1597

License: CC BY-NC-SA 4.0

Published Online: 18-01-2024

Copyright Statement:  Copyright © 2023; The Author(s).


Aim and background: The management of bone union disorders is a complex problem in orthopaedics, requiring a reliable and comprehensive classification system for accurate diagnosis and treatment. Despite advances in understanding pathophysiology, diagnosis, and treatment in this area, there is no generally accepted classification system. The aim of our work was to create a comprehensive classification, which will systemize the vast majority of bone union disorders, underline their differences and form the basis for their treatment. Methods: The key criteria for nonunion evaluation and treatment were identified based on the conducted literature review: Time from the initial event (delayed union or nonunion), location, type of pathology (A, Hypertrophic; B, Normotrophic; C, Oligotrophic) and the presence of hardware. Based on these criteria the ULBNC has been developed. Atrophic nonunions were excluded from this classification as they are considered segmental bone defects with special classification. Results: The ULBNC is based on the same principles of coding as the “gold standard” AO/OTA Fractures Classification system with alpha-numeric coding “from simple to complex.” The choice of treatment method depends on the type, group, and subgroup of the nonunion as described. Conclusion: Universal Long Bone Nonunion Classification (ULBNC) is an alphanumeric system that describes the localization, type of pathology and morphologic characteristics of a nonunion. The use of ULBNC in practice and research will optimize and standardize the treatment of various types of bone healing disorders and eventually improve clinical outcomes.

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